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Cuenca-Zaldivar JN, Monroy Acevedo Á, Fernández-Carnero J, Sánchez-Romero EA, Villafañe JH, Barragán Carballar C. Effects of a Multicomponent Exercise Program on Improving Frailty in Post-COVID-19 Older Adults after Intensive Care Units: A Single-Group Retrospective Cohort Study. BIOLOGY 2022; 11:biology11071084. [PMID: 36101461 PMCID: PMC9313031 DOI: 10.3390/biology11071084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 12/21/2022]
Abstract
Background: Older adult patients with post-COVID-19 syndrome present greater physical impairment accompanied by frailty than younger patients, which is why multicomponent exercise programs (MEP) are recommended for their positive effects on improving frailty and physical capacity. The aim of this study was to evaluate the effects of a short MEP (Vivifrail; <4 weeks) on improving frailty in post-COVID-19 older adults after intensive care units. Methods: To develop a retrospective cohort study, data were collected from the functional gait training program based on selected Vivifrail MEP in a single-group and applied to patients admitted with a diagnosis of post-COVID-19 functional impairment. The MEP was carried out for 3 weeks, with daily sessions lasting 40 min. Patients included were assessed at the beginning and at the end of the protocol by using the Short Performance Physical Battery (SPPB), the number of falls in the last year, the number of falls with medical attention, the Timed Up and Go (TUG) test, the presence of dementia, the Trunk Control Test (TCT), the Tinetti balance and gait test, Barthel Index, Medical Research Council Sum Score (MRCSS) and handgrip strength dynamometry. Results: The results of this study show statistically significant improvements in physical fitness and frailty with increases in the Short Physical Performance Battery (Z = 9.12, p < 0.001) by means of the MET applied in its short version (<4 weeks) showing even clinically relevant improvements (>2.5 points). Statistically significant improvements were also found in Medical Research Council Sum Score (Z = 12.345, p < 0.001), Barthel Index Score (Z = 12.272, p < 0.001), Trunk Control Test (Z = 12. 36, p < 0.001), Tinetti−POMA (Z = 12.293, p < 0.001) including the balance (Z = 12.11, p < 0.001), gait (Z = 12.164, p < 0.001) subscales and in the hand dynamometry (Z = 12.172, p < 0.001). Conclusions: The selected Vivifrail MEP is effective and safe for improving frailty in post-COVID-19 older adult’s patients.
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Affiliation(s)
- Juan Nicolás Cuenca-Zaldivar
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute—Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (J.N.C.-Z.); (Á.M.A.)
- Rehabilitation Service, Guadarrama Hospital, 28440 Madrid, Spain
| | - Álvaro Monroy Acevedo
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute—Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (J.N.C.-Z.); (Á.M.A.)
- Rehabilitation Service, Guadarrama Hospital, 28440 Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (J.F.-C.); (E.A.S.-R.); Tel.: +34-659-70-67-22 (J.F.-C.); +34-617-12-35-63 (E.A.S.-R.); Fax: +34-633-11-53-28 (E.A.S.-R.)
| | - Eleuterio A. Sánchez-Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (J.F.-C.); (E.A.S.-R.); Tel.: +34-659-70-67-22 (J.F.-C.); +34-617-12-35-63 (E.A.S.-R.); Fax: +34-633-11-53-28 (E.A.S.-R.)
| | | | - Carlos Barragán Carballar
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
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Application of a Multicomponent Exercise Program on Functional Capacity in Hip Fractures in Hospitalized Older Adults. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. THE GERONTOLOGIST 2021; 61:e23-e38. [PMID: 31942997 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal.,Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Sweden
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Petrucci L, Monteleone S, Ricotti S, Giromini E, Gullace M, Ambrosini E, Ferriero G, Dalla Toffola E. Disability after major abdominal surgery: determinants of recovery of walking ability in elderly patients. Eur J Phys Rehabil Med 2018; 54:683-689. [PMID: 29898583 DOI: 10.23736/s1973-9087.18.04348-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increased life expectancy and improved surgical techniques have led to a sharp rise in healthcare resource consumption by older patients. In these patients early recovery of walking ability after abdominal surgery may shorten length of hospital stay and reduce overall healthcare costs, but it is important to understand what factors determine this recovery. AIM To assess preoperative and postoperative determinants of walking ability recovery after major abdominal surgery in older patients. DESIGN Prospective observational study. SETTING General Surgery Unit. POPULATION The study included 327 consecutive older inpatients who underwent major acute-care abdominal surgery. METHODS Data on demographic characteristics, diagnosis, comorbidities defined by Charlson Comorbidity Index (CCI), preoperative walking ability, and early postoperative physical deconditioning (PPDS) were gathered. All patients underwent an individually-tailored rehabilitation program. At discharge, pain (by a Visual Analogue Scale, VAS-pain, 0-10), transfers and walking ability were assessed. Number of rehabilitation sessions attended and discharge setting were recorded. RESULTS Of 320 patients included in the analysis (7 died), 72% had CCI>5, signifying presence of >1 comorbidities. Before hospitalization, 79% of patients were completely independent in walking at home, 12% needed assistive devices or direct assistance from the caregiver, and 9% were unable to walk. Complex postoperative physical deconditioning was detected in 25%. At discharge, most patients (87%) had achieved their rehabilitative goal and returned home. Only PPDS and VAS-pain were able to predict both walking ability and the discharge setting, PPDS alone showing adequate sensitivity (82%) and specificity (70%). CONCLUSIONS PPDS was the sole early postoperative predictor of recovery of walking ability and the discharge setting. Pain therapy might be a key factor influencing the postoperative functional decline. Age and severity of preoperative comorbidities seem not important determinants of functional decline in older surgical patients. CLINICAL REHABILITATION IMPACT An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.
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Affiliation(s)
- Lucia Petrucci
- Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Serena Monteleone
- Department of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, IRCCS, Istituti Clinici Scientifici Maugeri, Lissone, Monza-Brianza, Italy
| | - Susanna Ricotti
- Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Erica Giromini
- Unit of Physical Medicine and Rehabilitation, Department of Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Mariangela Gullace
- Unit of Physical Medicine and Rehabilitation, Department of Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Giorgio Ferriero
- Department of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, IRCCS, Istituti Clinici Scientifici Maugeri, Lissone, Monza-Brianza, Italy
| | - Elena Dalla Toffola
- Unit of Physical Medicine and Rehabilitation, Department of Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy -
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Jurdana M, Jenko-Pražnikar Z, Mohorko N, Petelin A, Jakus T, Šimunič B, Pišot R. Impact of 14-day bed rest on serum adipokines and low-grade inflammation in younger and older adults. AGE (DORDRECHT, NETHERLANDS) 2015; 37:116. [PMID: 26564239 PMCID: PMC5005849 DOI: 10.1007/s11357-015-9848-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Ageing and inactivity both contribute to systemic inflammation, but the effects of inactivity on inflammation in healthy elderly individuals have not been elucidated. We hypothesised that 14-day bed rest could affect the pro- and anti-inflammatory markers in young subjects differently than in older adults. A short-term 14-day horizontal bed rest study (BR14) has been used as a model of inactivity in two groups of healthy male volunteers: 7 aged 18-30 years (young) and 16 aged 55-65 years (older adults). The effects of inactivity on inflammation were compared. Key low-grade inflammation mediators, tumour necrosis factor α (TNF-α), interleukin-6 (IL-6), visfatin, resistin, and anti-inflammatory adiponectin were measured in fasting serum samples, collected at baseline (BDC) and post BR14. Young responded to BR14 by increasing serum visfatin and resistin while older adults responded to BR14 by increasing IL-6 and TNF-α. In addition, serum adiponectin increased in all participants. Data from correlation analysis demonstrated positive association between Δ serum visfatin and Δ IL-6 in both groups, while Δ serum adiponectin was negatively associated with Δ TNF-α in young and positively associated with Δ resistin in the older adults. As little as 14 days of complete physical inactivity (BR14) negatively affected markers of low-grade inflammation in both groups, but the inflammation after BR14 was more pronounced in older adults. The effect of BR14 on IL-6 and resistin differed between young and older adults. Inflammatory responses to BR14 in older adults differed from those reported in the literature for obese or subjects in pathological states, suggesting potentially different mechanisms between inactivity- and obesity-induced inflammations.
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Affiliation(s)
- Mihaela Jurdana
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310, Izola, Slovenia.
- Science and Research Centre, University of Primorska, Garibaldijeva 1, SI-6000, Koper, Slovenia.
| | - Zala Jenko-Pražnikar
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310, Izola, Slovenia
| | - Nina Mohorko
- Science and Research Centre, University of Primorska, Garibaldijeva 1, SI-6000, Koper, Slovenia
| | - Ana Petelin
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310, Izola, Slovenia
| | - Tadeja Jakus
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310, Izola, Slovenia
| | - Boštjan Šimunič
- Science and Research Centre, University of Primorska, Garibaldijeva 1, SI-6000, Koper, Slovenia
| | - Rado Pišot
- Science and Research Centre, University of Primorska, Garibaldijeva 1, SI-6000, Koper, Slovenia
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Crawford H, Anderson S, TeKamp R, Chatzikiriakos V, Osborne D. Enhanced activation and restorative care. Healthc Manage Forum 2012; 25:4-15. [PMID: 22619874 DOI: 10.1016/j.hcmf.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As the Canadian population ages, it becomes increasingly important for hospitals to address and implement programs and policies that ensure elderly patients are receiving the right care in the right place at the right time. Despite the vast majority of elderly patients being healthier than ever, it is important to recognize the rapid deconditioning that occurs when they are admitted to an acute care hospital. Although it is recognized that children need to be treated differently, we fail to recognize the same is true for older adults. The Enhanced Activation Program was conceptualized during consultation with community partners while discussing the aging at home strategy. It was during these consultations that gaps in service for the frail elderly were identified and the Enhanced Activation Program was developed.
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